ManagementManagement
ofof
Health & Medical IssuesHealth & Medical Issues
inin
DisastersDisasters
Dr S.J.GandhiDr S.J.Gandh...
Seven Fundamental Terms in Risk ManagementSeven Fundamental Terms in Risk Management
A Logical Framework of TerminologyA L...
DefinitionsDefinitions
A Hazard is a Human-made or Natural Danger that causes damageA Hazard is a Human-made or Natural Da...
HazardsHazards
There are 4 classes of hazardThere are 4 classes of hazard::
1.1. Natural hazardsNatural hazards
2. Technol...
A Community Consists of 5A Community Consists of 5 Elements:Elements:
1.1. TheirTheir propertyproperty (infrastructure, po...
COMMUNITY RISKSCOMMUNITY RISKS
COMMUNITY RISKSCOMMUNITY RISKS are proportional toare proportional to
HAZARDSHAZARDS
xx
VUL...
VulnerabilitiesVulnerabilities
are:are:
Factors which determine how much riskFactors which determine how much risk
Higher ...
Indicators of VulnerabilitiesIndicators of Vulnerabilities
EachEach element of communityelement of community can be descri...
Indicators of Vulnerabilities (for people)Indicators of Vulnerabilities (for people)
• Access to health care
• Measles vac...
Critical Services – Basic Needs andCritical Services – Basic Needs and
LifelinesLifelines
Basic needs for survival:Basic n...
ConsequencesConsequences
– injury (mental and physical)injury (mental and physical)
– disease (mental and physical)disease...
Public Health Consequences of DisastersPublic Health Consequences of Disasters
• temporary population displacementstempora...
Public Health Consequences of Disasters -Public Health Consequences of Disasters -
cont.cont.
• environmental disruption c...
Health Services in EmergenciesHealth Services in Emergencies
– Mass casualty management – first aid, triage,Mass casualty ...
Health Sector Role in Relief
Health Assessment Surveillance Systems Organisation and Management
Structural damage and loss...
Challenges in HealthChallenges in Health
Emergency ManagementEmergency Management
– Lack of legal frameworks, policies, gu...
Challenges in HealthChallenges in Health
Emergency ManagementEmergency Management
– Multiples agencies involved - inter / ...
Challenges in HealthChallenges in Health
Emergency ManagementEmergency Management
– Lack or mismatch of resourcesLack or m...
HEALTH ISSUESHEALTH ISSUES
WATER & SANITATIONWATER & SANITATION
There was a breakdown of the water and sewerageThere was a...
SOCIAL ISSUESSOCIAL ISSUES
DISPOSAL OF DEAD BODIESDISPOSAL OF DEAD BODIES
The police was entrusted with the task ofThe pol...
ADMINISTRATIVE PROBLEMSADMINISTRATIVE PROBLEMS
COLLAPSE OF THE CIVIL HEALTH COMMAND AND CONTROLCOLLAPSE OF THE CIVIL HEALT...
ADMINISTRATIVE PROBLEMSADMINISTRATIVE PROBLEMS
HAPHAZARD INDUCTION OF CIVILIAN HEALTH PERSONNEL INTOHAPHAZARD INDUCTION OF...
PATIENT CARE DIFFICULTIESPATIENT CARE DIFFICULTIES
SHORTAGE OF HOSPITAL BEDS AND LINENSHORTAGE OF HOSPITAL BEDS AND LINEN
...
PATIENT CARE DIFFICULTIESPATIENT CARE DIFFICULTIES
CASUALTYCASUALTY
EVACUATION TOEVACUATION TO
OTHER HOSPITALSOTHER HOSPIT...
INFORMATION MANGEMENTINFORMATION MANGEMENT
Lack of communications.Lack of communications.
Assessment of the magnitude of t...
Rapid Assessment- Team compositionRapid Assessment- Team composition
Public health expert/ EpidemiologistPublic health exp...
SPHERESPHERE
Based on Two Principles:Based on Two Principles:
(a) Relieve and minimize human suffering arising out of cala...
Humanitarian CharterHumanitarian Charter
Based on the principles and provisions of InternationalBased on the principles an...
Sphere standards alsoSphere standards also relate to the operational framework andrelate to the operational framework and
...
Key Vulnerable Groups:Key Vulnerable Groups:
WomenWomen
Children (age<18 yrs.)Children (age<18 yrs.)
Older people (age > 6...
Gender Issues will always remain in Focus and priorityGender Issues will always remain in Focus and priority
Even the asse...
General PrinciplesGeneral Principles
Affected people’s capacities and available resources should be assessedAffected peopl...
Hygiene PromotionHygiene Promotion
Much depends upon effective exchange of information betweenMuch depends upon effective ...
Water SupplyWater Supply
Average water use for drinking, cooking and personal hygiene in anyAverage water use for drinking...
Water Supply….Water Supply….
Excessive Queuing will result inExcessive Queuing will result in
(1) reduced per capita water...
Water Supply….Water Supply….
Faecal colliforms Bacteria (>99% of which are E. Coli ) are anFaecal colliforms Bacteria (>99...
Water Supply….Water Supply….
Each household should have minimum two containers of 20 LitersEach household should have mini...
Excreta DisposalExcreta Disposal
Safe disposal of excreta creates the first barrier to excreta related disease,Safe dispos...
Excreta Disposal…..Excreta Disposal…..
During the initial phase of disaster mark-off an area to be used asDuring the initi...
Excreta Disposal….Excreta Disposal….
Separate water facility should be provided for hand washings andSeparate water facili...
Solid Waste DisposalSolid Waste Disposal
Organic wastes impose a constant danger ofOrganic wastes impose a constant danger...
Solid Waste Management…..Solid Waste Management…..
Medical wastes should be separated and disposed-off separatelyMedical w...
Solid Waste Disposal…Solid Waste Disposal…
At slaughter houses slaughter waste can often be disposed in aAt slaughter hous...
Drainage FacilitiesDrainage Facilities
Surface Water near human settlements may be coming from:Surface Water near human se...
Drainage Facilities….Drainage Facilities….
Sullage or Domestic waste water when gets mixed with human excreta=Sullage or D...
Health System in DisastersHealth System in Disasters
Accessibility to all without discriminationAccessibility to all witho...
Health Systems in Disasters……Health Systems in Disasters……
The average Base-line CMR for the least developed countries isT...
Health Systems in Disasters….Health Systems in Disasters….
Partner Health Agencies should adhere to the health standards a...
Health System in Disasters…..Health System in Disasters…..
Mobile clinics should be well planed for their routes, regulari...
Health Services in Disasters….Health Services in Disasters….
During disaster situations also patient’s rights to privacy,D...
Control of Communicable DiseaseControl of Communicable Disease
At the time of natural calamities between 60%-90% of deaths...
Control of communicable diseases….Control of communicable diseases….
First of all an estimation of Measles coverage of chi...
Control of Communicable Diseases…..Control of Communicable Diseases…..
Malaria- Diagnostic facilities are geared up to hav...
What is a Rapid HealthWhat is a Rapid Health
Assessment?Assessment?
““Collection of subjective and objectiveCollection of ...
Objectives of Rapid Health AssessmentsObjectives of Rapid Health Assessments
Collection objectives.Collection objectives.
...
Objectives of Rapid Health AssessmentsObjectives of Rapid Health Assessments
Analysis objectivesAnalysis objectives
– set ...
Questions Answered by aQuestions Answered by a
Rapid Health AssessmentRapid Health Assessment
– Is there an emergency or n...
The Purpose of HealthThe Purpose of Health
AssessmentsAssessments
To giveTo give decision makersdecision makers informatio...
Rapid Health Assessment:Rapid Health Assessment:
Common MistakesCommon Mistakes
– No policy or guidelines on assessmentNo ...
Rapid Health Assessment -Rapid Health Assessment -
Common MistakesCommon Mistakes
The biggest mistake in forms used by the...
What is Available in the EHAWhat is Available in the EHA
Webpage?Webpage?
Recap: the Purpose of AssessmentsRecap: the Purpose of Assessments
To giveTo give decision makersdecision makers informati...
Health Needs Assessments (DANA, RHA)
Reporting + Surveillance
Hospitals cough + fever
Clinics and Health Centers diarrhea ...
RAPID HEALTH ASSESSMENT FORMATSRAPID HEALTH ASSESSMENT FORMATS
FINAL REPORTFINAL REPORT
Rehabilitation Aspects in Disasters-Rehabilitation Aspects in Disasters-
PHEMAPPHEMAP
Dr. S. J. GandhiDr. S. J. Gandhi
Dep...
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
Manag. of health & medical issues in disasters modified14 03-2009
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Inter-departmental co-ordination and Community support aspects for the effective management of Disasters

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  • These are the seven items presented in a linked framework.
  • Examples will be covered later.
  • Community risks are a function of the relationship between hazards, vulnerabilities and capacities. The health consequences are the result of this interaction.
    Capacity refers to the capacity to reduce hazards, reduce vulnerability and the capacity to respond and recover from emergencies and disasters.
    This equation is only representative – it is not a straightforward mathematical formula.
    If hazards increase, the risk increases.
    If vulnerability increases, the risk increases.
    If capacity decreases, the risk increases.
    To reduce risk, we need to reduce hazards, reduce vulnerability, and increase capacities - therefore risk is lower.
  • Discuss the indicators which participants have identified. Introduce these indicators of vulnerability for impact of disasters on communities.
  • Compare this slide to the answers given by participants.
  • Reiterate some of the public health consequences of disasters
  • Reiterate some of the public health consequences of disasters
  • These are the specific services that the health sector must provide in order to meet the needs
  • Please present the WHO’s definition of a Rapid Health Assessment.
    At the onset of a crisis, a Rapid Health Assessment is used to recognise and quantify the emergency and to readjust strategies and plans accordingly.
    Once a programme of assistance is under way, periodic assessments will assist evaluation of the effectiveness of response and recovery.
    Highlight the difference between a post-disaster RHA and a Health Assessment in ‘normal’ conditions: RHA is driven by time constraints; the aim is to provide accurate rather than precise and extremely detailed information about the damage and the needs of the population, in order to meet these needs and restore their lifelines as quick as possible.
  • Please present this slide.
  • Please present this slide.
  • Please present this slide.
  • Please present this slid, comparing it with the answers given by participants.
  • Please compare the answers on this slide with those given by participants.
  • Please present this slide.
  • Please present this slide.
  • A detailed discussion of assessment criteria for a variety of specific health scenarios can be found in the WHO publication, “Rapid Assessment Protocols”, published 2000 in 10 parts.
  • Linking DANA to programme reporting and monitoring
    PUCD = potentially unstable chronic diseases e.g. diabetes, asthma, renal failure etc. – these also need attention in disasters
  • Manag. of health & medical issues in disasters modified14 03-2009

    1. 1. ManagementManagement ofof Health & Medical IssuesHealth & Medical Issues inin DisastersDisasters Dr S.J.GandhiDr S.J.Gandhi Deputy Director (Epidemic)Deputy Director (Epidemic) Commissioerate Of HealthCommissioerate Of Health Services, GandhinagarServices, Gandhinagar
    2. 2. Seven Fundamental Terms in Risk ManagementSeven Fundamental Terms in Risk Management A Logical Framework of TerminologyA Logical Framework of Terminology HazardHazard AnyAny potentialpotential threat to publicthreat to public safety and / or public healthsafety and / or public health RisksRisks TheThe potentialpotential consequencesconsequences of hazardof hazard interacting with communityinteracting with community EmergencyEmergency AnyAny actualactual threat to publicthreat to public safety and / or public healthsafety and / or public health VulnerabilitiesVulnerabilities Factors which determine the type andFactors which determine the type and severity of those consequencesseverity of those consequences DisasterDisaster AA civil emergencycivil emergency in which thein which the humanitarian needs arehumanitarian needs are beyond local capacity to meetbeyond local capacity to meet those needs i.e. the responsethose needs i.e. the response and recovery operation mustand recovery operation must be managed at the nationalbe managed at the national and/or international leveland/or international level Readiness for ResponseReadiness for Response A determinant of the severity andA determinant of the severity and manageability of those consequencesmanageability of those consequences CommunityCommunity isis people, property, services, livelihoods and environmentpeople, property, services, livelihoods and environment i.e. thei.e. the elements exposed to hazardselements exposed to hazards
    3. 3. DefinitionsDefinitions A Hazard is a Human-made or Natural Danger that causes damageA Hazard is a Human-made or Natural Danger that causes damage to people , property and the environmentto people , property and the environment A Risk is the Potential for something to go wrong or for somethingA Risk is the Potential for something to go wrong or for something harmful to occurharmful to occur Vulnerability is the potential to be easily hurt or harmedVulnerability is the potential to be easily hurt or harmed Capacity is an ability to cope up with a difficult situationCapacity is an ability to cope up with a difficult situation
    4. 4. HazardsHazards There are 4 classes of hazardThere are 4 classes of hazard:: 1.1. Natural hazardsNatural hazards 2. Technological hazards2. Technological hazards 3. Biological hazards3. Biological hazards 4. Societal hazards4. Societal hazards
    5. 5. A Community Consists of 5A Community Consists of 5 Elements:Elements: 1.1. TheirTheir propertyproperty (infrastructure, possessions and assets; public,(infrastructure, possessions and assets; public, private and cultural)private and cultural) 2.2. TheirTheir servicesservices (government and non-government, commercial and(government and non-government, commercial and voluntary)voluntary) 3.3. TheirTheir livelihoodslivelihoods (urban and rural, formal and informal)(urban and rural, formal and informal) 4.4. TheThe peoplepeople 5.5. TheirTheir environmentenvironment (air, water and soil; urban and rural, built and(air, water and soil; urban and rural, built and natural)natural)
    6. 6. COMMUNITY RISKSCOMMUNITY RISKS COMMUNITY RISKSCOMMUNITY RISKS are proportional toare proportional to HAZARDSHAZARDS xx VULNERABILITIESVULNERABILITIES ____________________________________________________ READINESS FOR RESPONSEREADINESS FOR RESPONSE
    7. 7. VulnerabilitiesVulnerabilities are:are: Factors which determine how much riskFactors which determine how much risk Higher vulnerability increases the risksHigher vulnerability increases the risks arising from a specific hazard in a specificarising from a specific hazard in a specific community, or in sub-sections of thatcommunity, or in sub-sections of that community.community.
    8. 8. Indicators of VulnerabilitiesIndicators of Vulnerabilities EachEach element of communityelement of community can be described in termscan be described in terms of its vulnerabilities:of its vulnerabilities: – peoplepeople – propertyproperty – servicesservices – livelihoodslivelihoods – environmentenvironment
    9. 9. Indicators of Vulnerabilities (for people)Indicators of Vulnerabilities (for people) • Access to health care • Measles vaccination coverage rate • Under 5 nutrition rate • Under 5 mortality rate • Access to safe water • Access to sanitation • Access to adequate housing • Access to regular source of income • Female literacy rates
    10. 10. Critical Services – Basic Needs andCritical Services – Basic Needs and LifelinesLifelines Basic needs for survival:Basic needs for survival: – waterwater – foodfood – shelter (and clothing in cold climates)shelter (and clothing in cold climates) – energy (fuel)energy (fuel) – (acute medical care)(acute medical care)
    11. 11. ConsequencesConsequences – injury (mental and physical)injury (mental and physical) – disease (mental and physical)disease (mental and physical) – secondary hazards (fire, disease etc.)secondary hazards (fire, disease etc.) – contamination of the environmentcontamination of the environment – displacementdisplacement – breakdown in securitybreakdown in security – damage to infrastructuredamage to infrastructure – dead and missingdead and missing – breakdown in essential servicesbreakdown in essential services – loss of propertyloss of property – loss of income …loss of income …
    12. 12. Public Health Consequences of DisastersPublic Health Consequences of Disasters • temporary population displacementstemporary population displacements • increased numbers of deaths and injuriesincreased numbers of deaths and injuries • new cases of disease and disabilitynew cases of disease and disability • exacerbation of and increased numbers of cases ofexacerbation of and increased numbers of cases of psychological and social behaviour disorderspsychological and social behaviour disorders • food shortages and nutritional deficienciesfood shortages and nutritional deficiencies
    13. 13. Public Health Consequences of Disasters -Public Health Consequences of Disasters - cont.cont. • environmental disruption causing hazards – vectors,environmental disruption causing hazards – vectors, waste management, sanitationwaste management, sanitation – destruction of infrastructuredestruction of infrastructure – disruption to routine health servicesdisruption to routine health services – disruption to routine disease surveillance and controldisruption to routine disease surveillance and control servicesservices – diversion of capital investment funds to emergencydiversion of capital investment funds to emergency relief and the rehabilitation or reconstruction ofrelief and the rehabilitation or reconstruction of essential infrastructureessential infrastructure
    14. 14. Health Services in EmergenciesHealth Services in Emergencies – Mass casualty management – first aid, triage,Mass casualty management – first aid, triage, transport, pre-hospital care, in-patient care, posttransport, pre-hospital care, in-patient care, post care follow-upcare follow-up – Management of the dead and missingManagement of the dead and missing – Environmental health (water and sanitation,Environmental health (water and sanitation, shelter, health care waste management,shelter, health care waste management, environmental pollution)environmental pollution) – Psychosocial servicesPsychosocial services – Reproductive healthReproductive health – Communicable disease control measuresCommunicable disease control measures – Feeding and nutritionFeeding and nutrition – Health information and communicationHealth information and communication
    15. 15. Health Sector Role in Relief Health Assessment Surveillance Systems Organisation and Management Structural damage and loss Community, hospital and laboratory Public information/media Staff/equipment damage and loss Public and private Guidelines and protocols Organisation and management needs Injury Referral systems Access and logistics needs Communicable diseases Emergency reporting system/HIS/MIS Programme needs: Water quality Management of the dead/forensics Acute medical/clinical care Nutritional status Supplies and equipment Surveillance and Laboratories disability Logistics, transport and communications Communicable Disease Control mental health Human resources Mental Health non communicable diseases Professional information and education Prerequisites for health vectors Research Medical Care Communicable Disease Control Prerequisites for Health Acute primary care/obstetrics Diseases of Epidemic Potential Shelter, energy, water and sanitation Care and treatment of injured Vaccine Preventable Diseases Environmental health Care and treatment of disability Vector Borne Diseases Nutrition and food supply Care and treatment of chronic disease Diseases of Public Health Significance Health promotion/information Reporting System Preparedness building the capacity to do ALL of the above Surge Capacity for: Response using AVAILABLE surge capacity scaling up health services restoration of essential services (repair/replace) reconstruction
    16. 16. Challenges in HealthChallenges in Health Emergency ManagementEmergency Management – Lack of legal frameworks, policies, guidelines,Lack of legal frameworks, policies, guidelines, protocolsprotocols – Lack of evidence base for policy developmentLack of evidence base for policy development – Pressure from the public and mediaPressure from the public and media – Emergency situations are dynamic and inEmergency situations are dynamic and in such situations, information is scarce, volatilesuch situations, information is scarce, volatile and often not sharedand often not shared – Multiple health effects of hazardsMultiple health effects of hazards
    17. 17. Challenges in HealthChallenges in Health Emergency ManagementEmergency Management – Multiples agencies involved - inter / intra-Multiples agencies involved - inter / intra- sectoral, public / private, national /sectoral, public / private, national / internationalinternational – Difficulty in coordinationDifficulty in coordination – Planning is not coordinated within andPlanning is not coordinated within and between sectorsbetween sectors – Plans do not exist or have not been testedPlans do not exist or have not been tested
    18. 18. Challenges in HealthChallenges in Health Emergency ManagementEmergency Management – Lack or mismatch of resourcesLack or mismatch of resources – Inappropriate donationsInappropriate donations – Response and recovery actions are doneResponse and recovery actions are done without needs assessmentswithout needs assessments – Opportunities for enhancing risk reduction areOpportunities for enhancing risk reduction are lost during recovery and reconstructionlost during recovery and reconstruction – Lessons from disasters are notLessons from disasters are not institutionalisedinstitutionalised – Lack of best practicesLack of best practices
    19. 19. HEALTH ISSUESHEALTH ISSUES WATER & SANITATIONWATER & SANITATION There was a breakdown of the water and sewerageThere was a breakdown of the water and sewerage system.system. HUMAN REFUSE GENERATIONHUMAN REFUSE GENERATION Relatives of injured people defecated / urinated in theRelatives of injured people defecated / urinated in the open, in spite of deep trench latrines.open, in spite of deep trench latrines. BIOMEDICAL WASTE DISPOSALBIOMEDICAL WASTE DISPOSAL Amputated limbs and other biomedical waste was disposedAmputated limbs and other biomedical waste was disposed off by burning.off by burning.
    20. 20. SOCIAL ISSUESSOCIAL ISSUES DISPOSAL OF DEAD BODIESDISPOSAL OF DEAD BODIES The police was entrusted with the task ofThe police was entrusted with the task of identification, photographing and cremation / burial ofidentification, photographing and cremation / burial of the dead bodiesthe dead bodies..
    21. 21. ADMINISTRATIVE PROBLEMSADMINISTRATIVE PROBLEMS COLLAPSE OF THE CIVIL HEALTH COMMAND AND CONTROLCOLLAPSE OF THE CIVIL HEALTH COMMAND AND CONTROL STRUCTURESTRUCTURE MH Bhuj whose role was to supplement civil resources had to serve as theMH Bhuj whose role was to supplement civil resources had to serve as the first responder.first responder. STRUCTURAL DAMAGE TO HOSPITALSTRUCTURAL DAMAGE TO HOSPITAL Patient care including surgery had to be carried out in the open under tentPatient care including surgery had to be carried out in the open under tent cover.cover. LACK OF COMMUNICATIONSLACK OF COMMUNICATIONS No serviceable telephone / satellite phone available at mh bhuj during the first 72No serviceable telephone / satellite phone available at mh bhuj during the first 72 hrshrs NO WATER OR ELECTRICITY SUPPLY INITIALLYNO WATER OR ELECTRICITY SUPPLY INITIALLY Generator sets became functional by 3 hrs post impact Water was provided throughGenerator sets became functional by 3 hrs post impact Water was provided through water- bowsers.water- bowsers.
    22. 22. ADMINISTRATIVE PROBLEMSADMINISTRATIVE PROBLEMS HAPHAZARD INDUCTION OF CIVILIAN HEALTH PERSONNEL INTOHAPHAZARD INDUCTION OF CIVILIAN HEALTH PERSONNEL INTO THE DISASTER AREATHE DISASTER AREA Personnel were inducted without adequate planning, briefing andPersonnel were inducted without adequate planning, briefing and preparation. They were not self contained.preparation. They were not self contained. LOGISTICS MANAGEMENT OF MEDICAL SUPPLIESLOGISTICS MANAGEMENT OF MEDICAL SUPPLIES Influx of medical supplies was not necessarily need based. Difficulties wereInflux of medical supplies was not necessarily need based. Difficulties were encountered in sorting out necessary items, accounting and storageencountered in sorting out necessary items, accounting and storage ABSENCE OF LAUNDRY SERVICES INITIALLYABSENCE OF LAUNDRY SERVICES INITIALLY Laundry services affected due to shortage of water and damage to theLaundry services affected due to shortage of water and damage to the washing point. Soiled linen could not be washed, disinfected and reused.washing point. Soiled linen could not be washed, disinfected and reused. SHORTAGE OF TENTSSHORTAGE OF TENTS No tents authorized to MH Bhuj on establishment. Tents had to be procuredNo tents authorized to MH Bhuj on establishment. Tents had to be procured from the local formation.from the local formation. DOCUMENTATIONDOCUMENTATION Adequate documentation of the massive influx of casualties was not possibleAdequate documentation of the massive influx of casualties was not possible with the existing resources.with the existing resources.
    23. 23. PATIENT CARE DIFFICULTIESPATIENT CARE DIFFICULTIES SHORTAGE OF HOSPITAL BEDS AND LINENSHORTAGE OF HOSPITAL BEDS AND LINEN MH Bhuj is a 99 bed hospital with a 25 bed crisis expansion capability. WithMH Bhuj is a 99 bed hospital with a 25 bed crisis expansion capability. With the large influx of casualties it ran out of hospital beds, mattresses and linen.the large influx of casualties it ran out of hospital beds, mattresses and linen. Patients had to be treated on the ground.Patients had to be treated on the ground. SHORTAGE OF OPERATING ROOM EQUIPMENT, INSTRUMENTS,SHORTAGE OF OPERATING ROOM EQUIPMENT, INSTRUMENTS, LINEN & DISINFECTANTSLINEN & DISINFECTANTS The capacity of the operating rooms was overwhelmed by the number of theThe capacity of the operating rooms was overwhelmed by the number of the casualties.casualties. CROWD CONTROLCROWD CONTROL Relatives of casualties demanded immediate attention from the limitedRelatives of casualties demanded immediate attention from the limited number of medical / paramedical personnel. They broke cordons andnumber of medical / paramedical personnel. They broke cordons and barged into treatment / operating areas, interfering with prioritization andbarged into treatment / operating areas, interfering with prioritization and provision of care.provision of care.
    24. 24. PATIENT CARE DIFFICULTIESPATIENT CARE DIFFICULTIES CASUALTYCASUALTY EVACUATION TOEVACUATION TO OTHER HOSPITALSOTHER HOSPITALS Inadequate number ofInadequate number of stretchers especiallystretchers especially special stretchers forspecial stretchers for transporting patients withtransporting patients with spinal injuries.spinal injuries. Data Collection Methods and Profiling during emergencies Inter-State Meeting on “Gujarat Earthquake: Health Sector Perspectives” 06-09 November 2001
    25. 25. INFORMATION MANGEMENTINFORMATION MANGEMENT Lack of communications.Lack of communications. Assessment of the magnitude of the disasterAssessment of the magnitude of the disaster impact was not available.impact was not available. Information on health facilities for redistribution /Information on health facilities for redistribution / evacuation of patients was not available.evacuation of patients was not available.
    26. 26. Rapid Assessment- Team compositionRapid Assessment- Team composition Public health expert/ EpidemiologistPublic health expert/ Epidemiologist ClinicianClinician MicrobiologistMicrobiologist Environmentalist/entomologistEnvironmentalist/entomologist
    27. 27. SPHERESPHERE Based on Two Principles:Based on Two Principles: (a) Relieve and minimize human suffering arising out of calamity and conflicts(a) Relieve and minimize human suffering arising out of calamity and conflicts (b) Affected community has a right to life with dignity and hence a right to(b) Affected community has a right to life with dignity and hence a right to receive assistancereceive assistance SPHERE initiative was launched in 1997 by a group of Humanitarian NGOs,SPHERE initiative was launched in 1997 by a group of Humanitarian NGOs, the Red Cross and Red Crescent movement –the Red Cross and Red Crescent movement – By framing Humanitarian CharterBy framing Humanitarian Charter By formulating minimum standards to be applied and achieved in areasBy formulating minimum standards to be applied and achieved in areas affected by all types of Disastrous situations in terms of Five key factorsaffected by all types of Disastrous situations in terms of Five key factors (water supply and sanitation, nutrition, food aid, shelter and health(water supply and sanitation, nutrition, food aid, shelter and health services)services) At present an Expert Group is working on the strategies of applyingAt present an Expert Group is working on the strategies of applying Sphere standards in Indian context and how best they can beSphere standards in Indian context and how best they can be modified to be applicable in current state of affairsmodified to be applicable in current state of affairs
    28. 28. Humanitarian CharterHumanitarian Charter Based on the principles and provisions of InternationalBased on the principles and provisions of International Humanitarian Law, International Human Rights Law,Humanitarian Law, International Human Rights Law, Refugee’s Law & Code of Conduct of International Red CrossRefugee’s Law & Code of Conduct of International Red Cross etc. during disaster reliefetc. during disaster relief It asserts the Human rights of people affected by natural orIt asserts the Human rights of people affected by natural or man-made disaster situations like armed conflicts, civil strifeman-made disaster situations like armed conflicts, civil strife and other political emergencies –to have protection, availand other political emergencies –to have protection, avail assistance to survive and live their life with dignityassistance to survive and live their life with dignity It also pertains to Legal responsibilities of the states andIt also pertains to Legal responsibilities of the states and warring parties to provide above services to the people underwarring parties to provide above services to the people under crisis situationcrisis situation If they are unable or unwilling to do so, they are obliged toIf they are unable or unwilling to do so, they are obliged to allow Humanitarian Organizations to provide humanitarianallow Humanitarian Organizations to provide humanitarian assistance and protectionassistance and protection
    29. 29. Sphere standards alsoSphere standards also relate to the operational framework andrelate to the operational framework and accountability aspects of service providersaccountability aspects of service providers In all situations priority would be meeting the urgent survivalIn all situations priority would be meeting the urgent survival needs of people affected by disastersneeds of people affected by disasters Ascertain their basic human right to life with dignityAscertain their basic human right to life with dignity In all contexts , disaster response should support and/orIn all contexts , disaster response should support and/or complement existing government services in terms of structure,complement existing government services in terms of structure, design and long term sustainabilitydesign and long term sustainability Providing valid information regarding availability and ensuringProviding valid information regarding availability and ensuring accessibility to support services by all groups in a non-accessibility to support services by all groups in a non- discriminatory manner as per their specific needs has to be co-discriminatory manner as per their specific needs has to be co- coordinated by continuous dialogue with Local Administrativecoordinated by continuous dialogue with Local Administrative AuthoritiesAuthorities
    30. 30. Key Vulnerable Groups:Key Vulnerable Groups: WomenWomen Children (age<18 yrs.)Children (age<18 yrs.) Older people (age > 60 yrs.)Older people (age > 60 yrs.) People with HIV/AIDSPeople with HIV/AIDS Ethnic MinoritiesEthnic Minorities Cross- cutting Issues:Cross- cutting Issues: Gender groupsGender groups Isolated groupsIsolated groups Malnourished groupsMalnourished groups Sensitive IssuesSensitive Issues ExploitationExploitation AbductionAbduction Recruitment into fighting forcesRecruitment into fighting forces Sexual violenceSexual violence Lack of opportunity to participate in decision makingLack of opportunity to participate in decision making Most harmful effects in such a situation will be felt by ChildrenMost harmful effects in such a situation will be felt by Children and young peopleand young people
    31. 31. Gender Issues will always remain in Focus and priorityGender Issues will always remain in Focus and priority Even the assessment teams should be framed up with equal participation byEven the assessment teams should be framed up with equal participation by Female MembersFemale Members Protection and Protection Assistance are two separate issues and NGOs canProtection and Protection Assistance are two separate issues and NGOs can certainly help in providing assistance to Local Authoritiescertainly help in providing assistance to Local Authorities HIV/AIDS plays it’s role in the way that as the Pandemic matures and moreHIV/AIDS plays it’s role in the way that as the Pandemic matures and more people die , communities would be left with disproportionate number ofpeople die , communities would be left with disproportionate number of children, orphans and older people- which require special attention andchildren, orphans and older people- which require special attention and relief programs may be modified accordinglyrelief programs may be modified accordingly Environmental Issues:Environmental Issues: The physical, chemical and biological environment in which affected people areThe physical, chemical and biological environment in which affected people are living in should not be subjected to over-exploitation, pollution andliving in should not be subjected to over-exploitation, pollution and degradationsdegradations NGOs also have to ensure their political clearance, fulfill their visa requirementsNGOs also have to ensure their political clearance, fulfill their visa requirements and should have sufficient financial, human and material resources of theirand should have sufficient financial, human and material resources of their own before they enter into above ventures.own before they enter into above ventures.
    32. 32. General PrinciplesGeneral Principles Affected people’s capacities and available resources should be assessedAffected people’s capacities and available resources should be assessed Identify gaps in essential servicesIdentify gaps in essential services Support inherent skills of local populationSupport inherent skills of local population No single sector can be planned and considered in isolationNo single sector can be planned and considered in isolation Share the findings of assessment with local populationShare the findings of assessment with local population Allow people to comment upon ongoing relief measuresAllow people to comment upon ongoing relief measures Plan outreach services for specific groups identifiedPlan outreach services for specific groups identified Disaster Response Programs should support and complement existingDisaster Response Programs should support and complement existing services and local institutions in terms of structure and designservices and local institutions in terms of structure and design Such activities should be sustainable after the external assistance stops andSuch activities should be sustainable after the external assistance stops and should be framed after due local consultations and approvalsshould be framed after due local consultations and approvals Host populations extending support to displaced populations should beHost populations extending support to displaced populations should be consulted and where appropriate the developments in disaster reliefconsulted and where appropriate the developments in disaster relief activities should also lead to a sustainable improvement in the livelihoods ofactivities should also lead to a sustainable improvement in the livelihoods of the host populationthe host population
    33. 33. Hygiene PromotionHygiene Promotion Much depends upon effective exchange of information betweenMuch depends upon effective exchange of information between people and service providers- should jointly list out risk factorspeople and service providers- should jointly list out risk factors It is in addition to good sanitation and water suppliesIt is in addition to good sanitation and water supplies Risk Factors: improper excreta disposal, use and maintenance ofRisk Factors: improper excreta disposal, use and maintenance of toilets, lack of hand-washing with soap, unhygienic storage of watertoilets, lack of hand-washing with soap, unhygienic storage of water and unhygienic storage and preparation of foodand unhygienic storage and preparation of food Form water and sanitation committees made from members fromForm water and sanitation committees made from members from various sections of community and half (50%) should be femalevarious sections of community and half (50%) should be female membersmembers Even such committees may be encouraged to manage water points,Even such committees may be encouraged to manage water points, public toilets and washing areaspublic toilets and washing areas This will ultimately sustain the efforts for a long long timeThis will ultimately sustain the efforts for a long long time
    34. 34. Water SupplyWater Supply Average water use for drinking, cooking and personal hygiene in anyAverage water use for drinking, cooking and personal hygiene in any household is at least 15 Liters per person per dayhousehold is at least 15 Liters per person per day The maximum distance from any household to the nearest water point isThe maximum distance from any household to the nearest water point is 500 meters500 meters Queuing time at a water source is no more than 15 minutesQueuing time at a water source is no more than 15 minutes It takes no more than Three minutes to fill a 20-liter water containerIt takes no more than Three minutes to fill a 20-liter water container Water sources and systems are adequately maintained so as to have aWater sources and systems are adequately maintained so as to have a consistent and continuous water supplyconsistent and continuous water supply Generally ground-water sources are preferred , as they require no treatmentGenerally ground-water sources are preferred , as they require no treatment People living with HIV/AIDS require extra water for drinking and personalPeople living with HIV/AIDS require extra water for drinking and personal hygienehygiene Requirements for Livestock and Agriculture crops have to paid attentionRequirements for Livestock and Agriculture crops have to paid attention especially in drought situationespecially in drought situation People affected by emergency situation have increased vulnerability toPeople affected by emergency situation have increased vulnerability to communicable diseases and their water requirements are more than normalcommunicable diseases and their water requirements are more than normal situationssituations
    35. 35. Water Supply….Water Supply…. Excessive Queuing will result inExcessive Queuing will result in (1) reduced per capita water consumption(1) reduced per capita water consumption (2) increased consumption from unprotected water sources(2) increased consumption from unprotected water sources (3) resulting in availability of less time for other survival tasks(3) resulting in availability of less time for other survival tasks In urban areas it may be necessary to supply water into individualIn urban areas it may be necessary to supply water into individual buildings to ensure that toilets continue to functionbuildings to ensure that toilets continue to function All users need to be informed when and where water will beAll users need to be informed when and where water will be availableavailable Important Quality Indicators:Important Quality Indicators: (1) There are no faecal colliforms per 100 ml at the point of delivery(1) There are no faecal colliforms per 100 ml at the point of delivery (2) Free Residual Chlorine 0.5 mg per Liter(2) Free Residual Chlorine 0.5 mg per Liter (3) Turbidity is below 5 NTU(3) Turbidity is below 5 NTU
    36. 36. Water Supply….Water Supply…. Faecal colliforms Bacteria (>99% of which are E. Coli ) are anFaecal colliforms Bacteria (>99% of which are E. Coli ) are an indicator of the level of human/animal waste contamination in waterindicator of the level of human/animal waste contamination in water Animal excreta is not as harmful as human excretaAnimal excreta is not as harmful as human excreta Disposal of Children Faeces requires more attention as they areDisposal of Children Faeces requires more attention as they are more dangerous than those of the adults because-more dangerous than those of the adults because- (1) In children excreta related infections are on a higher side(1) In children excreta related infections are on a higher side (2) Children lack antibodies(2) Children lack antibodies People have to be educated for the consumption of ChlorinatedPeople have to be educated for the consumption of Chlorinated water- in terms of health advantageswater- in terms of health advantages If the safe water does not taste good-people will continue to drinkIf the safe water does not taste good-people will continue to drink from unsafe water sources- thereby putting their health at riskfrom unsafe water sources- thereby putting their health at risk
    37. 37. Water Supply….Water Supply…. Each household should have minimum two containers of 20 LitersEach household should have minimum two containers of 20 Liters capacity to ensure continuous availabilitycapacity to ensure continuous availability Water collection and storage containers should have narrow necksWater collection and storage containers should have narrow necks At least 250 gms. of soap should be available per person per monthAt least 250 gms. of soap should be available per person per month If soap is not available-use alternatives like ash, clean sand , sodaIf soap is not available-use alternatives like ash, clean sand , soda or various plants for washing and scrubbingor various plants for washing and scrubbing At Communal Bathing facilities- sufficient cubicles should beAt Communal Bathing facilities- sufficient cubicles should be available separately for men and women groups and should beavailable separately for men and women groups and should be used appropriately and equitablyused appropriately and equitably At Communal Laundry facilities one washing cubicle is available perAt Communal Laundry facilities one washing cubicle is available per 100 persons100 persons Ensure private laundering facilities for women to wash and dry theirEnsure private laundering facilities for women to wash and dry their undergarments and sanitary clothsundergarments and sanitary cloths
    38. 38. Excreta DisposalExcreta Disposal Safe disposal of excreta creates the first barrier to excreta related disease,Safe disposal of excreta creates the first barrier to excreta related disease, helping to reduce transmission thro’ direct and indirect routeshelping to reduce transmission thro’ direct and indirect routes People need to provided with adequate no of toilets, sufficiently close theirPeople need to provided with adequate no of toilets, sufficiently close their residential premises to allow them rapid, safe and acceptable access at allresidential premises to allow them rapid, safe and acceptable access at all times of the day and nighttimes of the day and night Parameters:Parameters: (1) one toilet per 20 persons(1) one toilet per 20 persons (2) toilets segregated for men and women(2) toilets segregated for men and women (3) adequately cleaned and maintained(3) adequately cleaned and maintained (4) not more than 50 meters away from their dwellings(4) not more than 50 meters away from their dwellings (5) children Faeces are disposed off immediately(5) children Faeces are disposed off immediately At times of disasters it may necessary isolating parts of the system, whichAt times of disasters it may necessary isolating parts of the system, which are still working, re-routing of pipes, installing portable toilets and usingare still working, re-routing of pipes, installing portable toilets and using septic tanks and containment tanks – which are regularly desludgedseptic tanks and containment tanks – which are regularly desludged
    39. 39. Excreta Disposal…..Excreta Disposal….. During the initial phase of disaster mark-off an area to be used asDuring the initial phase of disaster mark-off an area to be used as defecation field or for trench latrinesdefecation field or for trench latrines Consult public-educate them on health benefits of using toilets and helpConsult public-educate them on health benefits of using toilets and help them to maintain toilets and keep them cleanthem to maintain toilets and keep them clean Sufficient no. of women cubicles need to be built up-roughly 3 times of men-Sufficient no. of women cubicles need to be built up-roughly 3 times of men- Wherever possible provide urinals for menWherever possible provide urinals for men People with HIV/AIDS frequently suffer with chronic diarrhea and require toPeople with HIV/AIDS frequently suffer with chronic diarrhea and require to use toilets moreuse toilets more Site selection should be such that all sections of people are able accessSite selection should be such that all sections of people are able access toilets easily-it should be particularly safe for women and girls throughouttoilets easily-it should be particularly safe for women and girls throughout the day and nightthe day and night Should provide privacyShould provide privacy Should allow for disposal of women’s sanitary protectionShould allow for disposal of women’s sanitary protection Should minimize fly and mosquito breedingShould minimize fly and mosquito breeding Should have adequate supply of water for anal cleansing an d keep themShould have adequate supply of water for anal cleansing an d keep them cleanclean
    40. 40. Excreta Disposal….Excreta Disposal…. Separate water facility should be provided for hand washings andSeparate water facility should be provided for hand washings and flushing after use of toiletsflushing after use of toilets Pit latrines and soakaways (for most soils ) should be at least 30Pit latrines and soakaways (for most soils ) should be at least 30 meters from any groundwater source and the bottom of any latrine ismeters from any groundwater source and the bottom of any latrine is at least 1.5 meters above the water tableat least 1.5 meters above the water table Community toilets should be provided with lightingCommunity toilets should be provided with lighting Toilet paper may be required in certain settings instead of waterToilet paper may be required in certain settings instead of water Women and girls who menstruate should have access to suitableWomen and girls who menstruate should have access to suitable materials for the absorption and disposal of menstrual bloodmaterials for the absorption and disposal of menstrual blood Soap-ash may be proidedSoap-ash may be proided Toilets with water-seal, ventilated improved pit latrine design orToilets with water-seal, ventilated improved pit latrine design or correct use of a lid on a squat hole may encourage constant use bycorrect use of a lid on a squat hole may encourage constant use by peoplepeople
    41. 41. Solid Waste DisposalSolid Waste Disposal Organic wastes impose a constant danger ofOrganic wastes impose a constant danger of (1) Fly and Rodent breeding(1) Fly and Rodent breeding (2) Surface water pollution(2) Surface water pollution (3) create an ugly and depressive feeling(3) create an ugly and depressive feeling (4) Block drainage channels(4) Block drainage channels Parameters:Parameters: (1) Involve people in designing and management of waste disposal(1) Involve people in designing and management of waste disposal ProgrammeProgramme (2) Household wastes are put in containers(2) Household wastes are put in containers (3) Communal Refuse container should be available within 100(3) Communal Refuse container should be available within 100 meters vicinitymeters vicinity (4) 100-liter refuse container should be available per 10 families(4) 100-liter refuse container should be available per 10 families
    42. 42. Solid Waste Management…..Solid Waste Management….. Medical wastes should be separated and disposed-off separatelyMedical wastes should be separated and disposed-off separately In disaster situation there is more possibility of infectious sharps andIn disaster situation there is more possibility of infectious sharps and non-sharps e.g. wound-dressings, blood stained clothes ,placentas..non-sharps e.g. wound-dressings, blood stained clothes ,placentas.. Safety boxes need to be provided to HCWs.Safety boxes need to be provided to HCWs. Disposal may be done by on-site burial or incinerationDisposal may be done by on-site burial or incineration At public places like markets. slaughter houses Refuse pits, Bins orAt public places like markets. slaughter houses Refuse pits, Bins or specified areas should be clearly marked and appropriately fencedspecified areas should be clearly marked and appropriately fenced In case of disposal of waste by Burial method it should covered withIn case of disposal of waste by Burial method it should covered with a thin layer of soil at least once in a week to prevent it gettinga thin layer of soil at least once in a week to prevent it getting attracted by vectors like flies and rodents and becoming a breedingattracted by vectors like flies and rodents and becoming a breeding site for themsite for them Such burial sites should also be fencedSuch burial sites should also be fenced Prevent any laechate from such sites contaminating ground waterPrevent any laechate from such sites contaminating ground water
    43. 43. Solid Waste Disposal…Solid Waste Disposal… At slaughter houses slaughter waste can often be disposed in aAt slaughter houses slaughter waste can often be disposed in a large pit with a hole cover next to abattoirlarge pit with a hole cover next to abattoir Blood etc. can be run from the abattoir into the pit through a slab –Blood etc. can be run from the abattoir into the pit through a slab – covered channel (reducing fly access to the pit)covered channel (reducing fly access to the pit) Water should be made available for cleaning purposeWater should be made available for cleaning purpose Controlled Tipping/Sanitary Land-fill:Controlled Tipping/Sanitary Land-fill: (a) useful for large scale off-site disposal of waste(a) useful for large scale off-site disposal of waste (b) Sufficient space and mechanical equipments are required(b) Sufficient space and mechanical equipments are required (c) Waste that is tipped should be covered by soil at the end of each(c) Waste that is tipped should be covered by soil at the end of each day to prevent scavenging and vector breedingday to prevent scavenging and vector breeding In all settings staff engaged in above work should be provided withIn all settings staff engaged in above work should be provided with protective gloves, boots , masks ,soap and availability of waterprotective gloves, boots , masks ,soap and availability of water
    44. 44. Drainage FacilitiesDrainage Facilities Surface Water near human settlements may be coming from:Surface Water near human settlements may be coming from: (1) household and water point Wastewater(1) household and water point Wastewater (2) leaking toilets and sewers(2) leaking toilets and sewers (3) rainwater or rising floodwater(3) rainwater or rising floodwater Health Risks:Health Risks: (1) contamination of water supplies and the living environment(1) contamination of water supplies and the living environment (2) damage to toilets and dwellings(2) damage to toilets and dwellings (3) vector breeding &(3) vector breeding & (4) drowning(4) drowning Important Considerations:Important Considerations: (1) areas around water points and dwellings are kept free from standing wastewater(1) areas around water points and dwellings are kept free from standing wastewater (2) storm-water drains are kept clear(2) storm-water drains are kept clear (3) Water point drainage from washing and bathing points are well planned and(3) Water point drainage from washing and bathing points are well planned and maintainedmaintained (4) drainage water should not pollute existing surface or ground water sources or(4) drainage water should not pollute existing surface or ground water sources or erode themerode them (5) adequate tools ,equipments and human workforce is available for maintainance(5) adequate tools ,equipments and human workforce is available for maintainance
    45. 45. Drainage Facilities….Drainage Facilities…. Sullage or Domestic waste water when gets mixed with human excreta=Sullage or Domestic waste water when gets mixed with human excreta= SewageSewage In human settlements during disasters also domestic wastewater should notIn human settlements during disasters also domestic wastewater should not allowed get mixed with human excretaallowed get mixed with human excreta Sewage is more difficult and expensive to treat than domestic wastewaterSewage is more difficult and expensive to treat than domestic wastewater At water points and washing and bathing areas encourage to create smallAt water points and washing and bathing areas encourage to create small gardens to utilize wastewatergardens to utilize wastewater Specially protect toilets and sewers from flooding to avoid structural damageSpecially protect toilets and sewers from flooding to avoid structural damage and leakageand leakage Local community should be involved in providing small scale drainage worksLocal community should be involved in providing small scale drainage works as they have good knowledge of the natural flow of drainage water andas they have good knowledge of the natural flow of drainage water and where channels should be putwhere channels should be put If off site disposal of wastewater is planned channels should be designed toIf off site disposal of wastewater is planned channels should be designed to have sufficient flow-velocity for dry-weather sullage and to carry storm waterhave sufficient flow-velocity for dry-weather sullage and to carry storm water Where the slope is more than 5% apply proper engineering methods toWhere the slope is more than 5% apply proper engineering methods to prevent excessive erosionprevent excessive erosion Drainage of residuals from any water treatment processes should beDrainage of residuals from any water treatment processes should be carefully controlledcarefully controlled
    46. 46. Health System in DisastersHealth System in Disasters Accessibility to all without discriminationAccessibility to all without discrimination Well trained professionalsWell trained professionals During armed conflicts , medical facilities and civilian hospitals should notDuring armed conflicts , medical facilities and civilian hospitals should not be targeted for attackbe targeted for attack Health and medical staff have rights to get protectedHealth and medical staff have rights to get protected Public Health impacts may be seen in terms of injuries, psychologicalPublic Health impacts may be seen in terms of injuries, psychological traumas, increased rates of infectious diseases, malnutrition, complicationstraumas, increased rates of infectious diseases, malnutrition, complications of chronic disease etcof chronic disease etc Interventions should be planed on evidence based practices- like adequateInterventions should be planed on evidence based practices- like adequate quantity of safe water, sanitation, nutritional supplements, food aid/ security,quantity of safe water, sanitation, nutritional supplements, food aid/ security, shelter and basic clinical careshelter and basic clinical care Health system beneficiaries are mostly women and childrenHealth system beneficiaries are mostly women and children Success Indicator of Health services is limitation of crude death rate as wellSuccess Indicator of Health services is limitation of crude death rate as well as under-5 mortality rate to Less than twice the Baseline rate documentedas under-5 mortality rate to Less than twice the Baseline rate documented
    47. 47. Health Systems in Disasters……Health Systems in Disasters…… The average Base-line CMR for the least developed countries isThe average Base-line CMR for the least developed countries is approximately 0.38 deaths/ 10000 / dayapproximately 0.38 deaths/ 10000 / day Health agencies should aim to keep CMR at below 1.0/ 10000/ dayHealth agencies should aim to keep CMR at below 1.0/ 10000/ day When the <5 CMR is unknown , Health agencies should aim toWhen the <5 CMR is unknown , Health agencies should aim to maintain this rate below 2.0 / 10000/ daymaintain this rate below 2.0 / 10000/ day No alternate parallel Hospitals / Health facilities should be createdNo alternate parallel Hospitals / Health facilities should be created by Partners , unless it is clearly indicated by local health authoritiesby Partners , unless it is clearly indicated by local health authorities When the local health authority is not in a position to take a lead inWhen the local health authority is not in a position to take a lead in crisis situation, this job can be taken over by United Nationscrisis situation, this job can be taken over by United Nations Authority like WHO, UNICEF etcAuthority like WHO, UNICEF etc After initial Health Assessment , a Health Document should beAfter initial Health Assessment , a Health Document should be created which mentions Health sector priorities and objectives-to becreated which mentions Health sector priorities and objectives-to be shared with all Partners to achieve itshared with all Partners to achieve it
    48. 48. Health Systems in Disasters….Health Systems in Disasters…. Partner Health Agencies should adhere to the health standards andPartner Health Agencies should adhere to the health standards and guidelines of the country including treatment protocols and essentialguidelines of the country including treatment protocols and essential drug listsdrug lists It is advisable to provide resources to existing hospitals so that theyIt is advisable to provide resources to existing hospitals so that they can start working again or cope with the extra loadcan start working again or cope with the extra load If at all a Base Hospital is necessary to establish, it should not drainIf at all a Base Hospital is necessary to establish, it should not drain on local resources , but should be able function on it’s own and iton local resources , but should be able function on it’s own and it must also be cost-effectivemust also be cost-effective All the Health Agencies need to coordinate with local / nodal healthAll the Health Agencies need to coordinate with local / nodal health authority for their allocated responsibilitiesauthority for their allocated responsibilities A standardized Referral System should be established by LocalA standardized Referral System should be established by Local /Nodal Authority and has to used by identical protocols by all/Nodal Authority and has to used by identical protocols by all Priority Health Messages to be spread to local population have to bePriority Health Messages to be spread to local population have to be developed by consensus and should be consistent for the contentsdeveloped by consensus and should be consistent for the contents
    49. 49. Health System in Disasters…..Health System in Disasters….. Mobile clinics should be well planed for their routes, regularity ofMobile clinics should be well planed for their routes, regularity of comprehensive services and avoid duplications of visitscomprehensive services and avoid duplications of visits Standardized management protocols need to develop and to be adhered byStandardized management protocols need to develop and to be adhered by allall Drug donations are accepted only if they follow internationally recognizedDrug donations are accepted only if they follow internationally recognized guidelinesguidelines While staffing at treatment facility ,ensure to post at least one female healthWhile staffing at treatment facility ,ensure to post at least one female health worker and one representative of a minority ethnic group which will increaseworker and one representative of a minority ethnic group which will increase utilization of health care facility by women and people from minority groupsutilization of health care facility by women and people from minority groups In normal circumstance utilization rate would be 0.5-1.0 consultation /personIn normal circumstance utilization rate would be 0.5-1.0 consultation /person /year/year Among displaced populations: 4.0 consultations/ person /yearAmong displaced populations: 4.0 consultations/ person /year Utilization should be equally represented amongst vulnerable groups likeUtilization should be equally represented amongst vulnerable groups like women, children and persons belonging to minority-ethnic groupswomen, children and persons belonging to minority-ethnic groups
    50. 50. Health Services in Disasters….Health Services in Disasters…. During disaster situations also patient’s rights to privacy,During disaster situations also patient’s rights to privacy, confidentiality and dignity and informed consent have to enforcedconfidentiality and dignity and informed consent have to enforced Drug management to be done on four basic principles i.e. selection,Drug management to be done on four basic principles i.e. selection, procurement, distribution and useprocurement, distribution and use Bodies of deceased persons pose dangers from public health pointBodies of deceased persons pose dangers from public health point of view only during specific instances of Cholera and Haemorregicof view only during specific instances of Cholera and Haemorregic feversfevers Health Information system should generate critical data-onlyHealth Information system should generate critical data-only essential information is collectedessential information is collected Data should be analyzed-feed back provided for timely actionsData should be analyzed-feed back provided for timely actions Surveillance data should be able to provide warning signalsSurveillance data should be able to provide warning signals Data should be shared by all working PartnersData should be shared by all working Partners
    51. 51. Control of Communicable DiseaseControl of Communicable Disease At the time of natural calamities between 60%-90% of deaths areAt the time of natural calamities between 60%-90% of deaths are contributed by Four major communicable diseases namely-Measles,contributed by Four major communicable diseases namely-Measles, Diarrhea, Acute respiratory infections and MalariaDiarrhea, Acute respiratory infections and Malaria In no. of cases Acute Malnutrition is noticed as an Associated causeIn no. of cases Acute Malnutrition is noticed as an Associated cause In certain disasters there have been increased no. of cases ofIn certain disasters there have been increased no. of cases of Meningococcal Meningitis, Yellow Fever, Viral Hepatitis and TyphoidMeningococcal Meningitis, Yellow Fever, Viral Hepatitis and Typhoid As such outbreaks of communicable diseases are far lessAs such outbreaks of communicable diseases are far less commonly associated with acute onset natural disasterscommonly associated with acute onset natural disasters General Preventive measures like water and sanitation, food-aidGeneral Preventive measures like water and sanitation, food-aid and food-security, shelter etc. are coordinated by other sectorsand food-security, shelter etc. are coordinated by other sectors Measles prevention is particularly indicated amongst displacedMeasles prevention is particularly indicated amongst displaced population or the population affected by conflictpopulation or the population affected by conflict
    52. 52. Control of communicable diseases….Control of communicable diseases…. First of all an estimation of Measles coverage of children aged between 9First of all an estimation of Measles coverage of children aged between 9 months to 15 years is donemonths to 15 years is done If above coverage is found to be Less than 90%, a Mass MeaslesIf above coverage is found to be Less than 90%, a Mass Measles Vaccination campaign for all children in the age group 06 months-15 yearsVaccination campaign for all children in the age group 06 months-15 years is initiatedis initiated Simultaneously Vitamin – A is given to all children between 06-59 monthsSimultaneously Vitamin – A is given to all children between 06-59 months Above activities should achieve minimum 95% coverageAbove activities should achieve minimum 95% coverage All infants vaccinated between 6-9 months should receive another dose ofAll infants vaccinated between 6-9 months should receive another dose of Measles vaccine upon reaching 09 monthsMeasles vaccine upon reaching 09 months Routine Programme of EPI is re-established to sustain 95% coverageRoutine Programme of EPI is re-established to sustain 95% coverage For mobile or displaced populations activities are planned in such a way thatFor mobile or displaced populations activities are planned in such a way that at any point of time at least 95% coverage is maintained amongst allat any point of time at least 95% coverage is maintained amongst all newcomersnewcomers Reasons for including children of 06-15 yrs in Measles vaccination: someReasons for including children of 06-15 yrs in Measles vaccination: some older children may have escaped both earlier measles vaccination andolder children may have escaped both earlier measles vaccination and measles disease also-hence they are vulnerable-and can serve as a sourcemeasles disease also-hence they are vulnerable-and can serve as a source of infection for infants and young children , who are at a higher risk of dyingof infection for infants and young children , who are at a higher risk of dying from the diseasefrom the disease
    53. 53. Control of Communicable Diseases…..Control of Communicable Diseases….. Malaria- Diagnostic facilities are geared up to have lab confirmation in 24Malaria- Diagnostic facilities are geared up to have lab confirmation in 24 hours in every casehours in every case Anti-malarial drugs are given in prescribed doses for the period specified inAnti-malarial drugs are given in prescribed doses for the period specified in the Programmethe Programme Vector control measures and distribution of Insecticide treated mosquitoVector control measures and distribution of Insecticide treated mosquito nets are synchronizednets are synchronized Patients of Tuberculosis are treated as per RNTCP guidelines by DOTPatients of Tuberculosis are treated as per RNTCP guidelines by DOT therapytherapy Single case=outbreak: stands true in diseases like Cholera, Measles, YellowSingle case=outbreak: stands true in diseases like Cholera, Measles, Yellow fever, Shigella and Viral Haemorregic Feversfever, Shigella and Viral Haemorregic Fevers Meningococcal Meningitis:Meningococcal Meningitis: (a) for areas with >30,000 population:- 15 cases/100,000/week indicates an(a) for areas with >30,000 population:- 15 cases/100,000/week indicates an outbreak situationoutbreak situation (b) if no outbreaks of meningitis have occurred in previous +3 years and if(b) if no outbreaks of meningitis have occurred in previous +3 years and if vaccination coverage is< 80%- there is High outbreak risk- above thresh-vaccination coverage is< 80%- there is High outbreak risk- above thresh- hold would be 10 cases/100,000/weekhold would be 10 cases/100,000/week (c) for areas with <30,000 population:- incidence of 5 cases in one week or(c) for areas with <30,000 population:- incidence of 5 cases in one week or doubling of cases over a three week period confirms an outbreakdoubling of cases over a three week period confirms an outbreak
    54. 54. What is a Rapid HealthWhat is a Rapid Health Assessment?Assessment? ““Collection of subjective and objectiveCollection of subjective and objective information in order to measureinformation in order to measure damagedamage and identify those basicand identify those basic needsneeds of the affected population that requireof the affected population that require immediateimmediate response”response” Rapid Health Assessment protocols for emergencies, WHO, 1999Rapid Health Assessment protocols for emergencies, WHO, 1999
    55. 55. Objectives of Rapid Health AssessmentsObjectives of Rapid Health Assessments Collection objectives.Collection objectives. – identify existing and potential public health needsidentify existing and potential public health needs – identify gaps and problems in meeting urgent medicalidentify gaps and problems in meeting urgent medical needsneeds – assess existing and potential environmental riskassess existing and potential environmental risk factorsfactors – assess resource and logistics needsassess resource and logistics needs – identify managerial, coordination and organisationalidentify managerial, coordination and organisational gaps, overlaps and problemsgaps, overlaps and problems
    56. 56. Objectives of Rapid Health AssessmentsObjectives of Rapid Health Assessments Analysis objectivesAnalysis objectives – set priorities for response / reliefset priorities for response / relief – set priorities for information dissemination andset priorities for information dissemination and communicationcommunication – identify resources needed to meet priorities – externalidentify resources needed to meet priorities – external and internaland internal – identify additional information needs for the responseidentify additional information needs for the response and for planning recovery and reconstructionand for planning recovery and reconstruction
    57. 57. Questions Answered by aQuestions Answered by a Rapid Health AssessmentRapid Health Assessment – Is there an emergency or not?Is there an emergency or not? – What is the existing response capacity?What is the existing response capacity? – What decisions need to be made?What decisions need to be made? – What information is needed to make theseWhat information is needed to make these decisions?decisions? – What are the sources of that information?What are the sources of that information?
    58. 58. The Purpose of HealthThe Purpose of Health AssessmentsAssessments To giveTo give decision makersdecision makers information that willinformation that will allow them to makeallow them to make timelytimely andand appropriateappropriate interventions to:interventions to: • save livessave lives • minimise injury and illnessminimise injury and illness • prevent escalation of the emergencyprevent escalation of the emergency • prevent spreadprevent spread • support recovery planningsupport recovery planning
    59. 59. Rapid Health Assessment:Rapid Health Assessment: Common MistakesCommon Mistakes – No policy or guidelines on assessmentNo policy or guidelines on assessment – No standard collection formatsNo standard collection formats – No training in assessment skillsNo training in assessment skills – Different sectors use different terms and methodsDifferent sectors use different terms and methods – Data cannot be consolidatedData cannot be consolidated – Too much irrelevant/duplicate data collectedToo much irrelevant/duplicate data collected – Too much time takenToo much time taken – accurate is better than– accurate is better than preciseprecise – Those collecting the data don’t know how it will beThose collecting the data don’t know how it will be used and don’t have the opportunity to improve theused and don’t have the opportunity to improve the assessment systemassessment system
    60. 60. Rapid Health Assessment -Rapid Health Assessment - Common MistakesCommon Mistakes The biggest mistake in forms used by theThe biggest mistake in forms used by the health sector is that they focus too muchhealth sector is that they focus too much on collecting (unavailable or unreliable)on collecting (unavailable or unreliable) morbidity and mortality data rather thanmorbidity and mortality data rather than health sector function informationhealth sector function information
    61. 61. What is Available in the EHAWhat is Available in the EHA Webpage?Webpage?
    62. 62. Recap: the Purpose of AssessmentsRecap: the Purpose of Assessments To giveTo give decision makersdecision makers information thatinformation that will allow them to makewill allow them to make timelytimely andand appropriateappropriate interventions to:interventions to: • save livessave lives • minimise injury and illnessminimise injury and illness • prevent escalationprevent escalation • prevent spreadprevent spread • support recovery planningsupport recovery planning
    63. 63. Health Needs Assessments (DANA, RHA) Reporting + Surveillance Hospitals cough + fever Clinics and Health Centers diarrhea + fever Laboratories headache + fever PHC Programmes: rash + fever nutrition myalgia + fever IMCI - epi, ari, cdd etc other fever water and sanitation malnutrition <5s vector control trauma, disability MCH, safe motherhood DEP, VBD, VPD, DPHS, PUCD ? workload ? investigation expected needs unexpected needs ? enough supplies ? new supplies ? enough staff ? new staff ? referral system working ? new referral system institution focus disease focus are we meeting the needs? dailydaily
    64. 64. RAPID HEALTH ASSESSMENT FORMATSRAPID HEALTH ASSESSMENT FORMATS
    65. 65. FINAL REPORTFINAL REPORT
    66. 66. Rehabilitation Aspects in Disasters-Rehabilitation Aspects in Disasters- PHEMAPPHEMAP Dr. S. J. GandhiDr. S. J. Gandhi Deputy Director (Epidemic)Deputy Director (Epidemic) Commissioner ate of Health ServicesCommissioner ate of Health Services GandhinagarGandhinagar

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